Varicose Veins Treatment Covered by Health Insurance

Varicose veins treatment is covered by health insurance when recommended for medical reasons. Talk to the experts to learn all about the terms and conditions of health insurance coverage for varicose veins.

Varicose veins treatment is covered by health insurance when recommended for medical reasons. Talk to the experts to learn all about the terms ... and conditions of health insurance coverage for varicose veins. Read More

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Is Varicose Veins Covered by Insurance?

To get varicose veins treatment covered by insurance, the patient has to justify that the treatment is medically necessary. If varicose veins are not causing any symptoms, the treatment proposed by the doctor is considered cosmetic, hence, the expenses won’t be covered by any type of insurance.

The following criteria are used to determine whether or not varicose vein treatment is medically necessary or not.

• The condition must be symptomatic, i.e., the patient must have physical symptoms, such as leg pain, heaviness, persistent swelling, cramping, etc. These symptoms indicate that the condition has advanced and can cause serious complications that can be life-threatening.
• The symptoms are affecting the patient’s daily life and their ability to carry out basic activities, including standing or walking.
• The patient has already tried conservative treatments for several weeks without any improvement. Conservative treatments include stockings, leg elevation, exercise, weight loss, anti-inflammatory medications, hot/cold packs, etc. Documentation of these treatments should also be available.
• The underlying venous insufficiency must be indicated through an ultrasound exam.

If all these requirements for medically necessary treatment are fulfilled, the insurance company will approve the claim to cover the treatment expenses.

Expenses of Varicose Veins Treatment Covered by Insurance

The standard base coverage offered by health insurance plans includes the following expenses-

• The doctor’s consultation and operating fee
• Anesthesia and anesthesiologist fee
• Hospital admission and discharge fee
• OT and ICU charges (calculated on an hourly basis)
• Room rent- single, double, or sharing occupancy (calculated on a daily basis)
• Medicines and IVs given to the patient during the hospital stay
• Medical consumables, including dressings, syringes, catheters, gloves, etc.
• Meal charges and nursing fee
• Post-surgery follow-up consultations

The insurance policy can be further customized to get additional coverage by paying higher premiums. The policyholder can opt for add-on coverage to maximize the coverage and benefits of the health insurance plan.

How to Claim Health Insurance for Varicose Veins Treatment?

The sole purpose of having a health insurance plan is to use it in times of need. To use the policy to cover the treatment expenses, the patient needs to raise a claim. An insurance policy can be claimed in two ways which are explained below-

Cashless Claim

A cashless claim is the type of claim which is settled by the insurer with the hospital directly. However, this type of insurance can only be claimed when the patient is getting treatment at a network hospital of the insurance company.

The steps to get a cashless claim involve the following-

• Intimate the insurance company regarding the treatment at least 2-5 days ago in case of planned treatment. If the surgery is performed on an emergency basis, inform the insurer within 24-48 hours of hospitalization.
• Provide a health card or e-card at the TPA desk of the hospital along with ID proof and other documents. The documents can be handed over a few days ago before the surgery is planned or on the day of admission.
• The TPA team of the hospital will submit the claim form filled by the patient along with other relevant documents, such as diagnostic tests report, disease certificate signed by a certified doctor, proposed treatment plan, etc.
• The insurance company will review the pre-authorization form at approve the cashless claim according to the terms and conditions of the insurance policy.

Once the claim is approved, the patient won’t have to pay anything during discharge as the expenses will be paid by the health insurance policy.

Reimbursement Claim

In this type of claim, the policyholder pays the hospital bills upfront at the time of discharge and files the claim request to get compensation or reimbursement from the insurance company. This claim can be raised at any network and non-network hospital.

The process to get a reimbursement claim is explained below-

• Inform the health insurance provider about the treatment at the earliest.
• Get the treatment and pay the treatment expenses during the discharge and gather all the medical records.
• Talk to the insurance company, get the reimbursement claim form, and fill it in with exact details.
• Submit the claim and respective documents to the insurance company.
• The insurers will review and verify the documents and process the claim depending on the terms and conditions of the policy.
• The approved claim amount is either credited to the policyholder’s bank account directly, or a cheque is issued in his/her name.

One thing to keep in mind is that the reimbursement claim can only be filed within 30 days of discharge. If the claim is raised after that, the insurance company holds the right to deny the claim request.

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